Structural Vulnerability and Malaria Care-Seeking during Pregnancy in Siaya County, Kenya

Abstract

Malaria in pregnancy remains a major cause of maternal anaemia, low birth weight, stillbirth, and neonatal death in sub-Saharan Africa, despite the availability of effective biomedical interventions. In Kenya, strategies such as intermittent preventive treatment in pregnancy (IPTp), insecticide-treated nets (ITNs), and free maternal healthcare are widely implemented; however, utilisation and outcomes remain uneven across high-transmission counties. This study examined how structural vulnerability, influenced by socio-demographic and economic factors, affects malaria care-seeking among pregnant women in Siaya County, western Kenya. Using a mixed-methods cross-sectional design, the study combined a household survey (n = 341) with in-depth interviews, narrative interviews, and focus group discussions involving pregnant women, women who recently delivered, male partners, community health volunteers, traditional birth attendants, and traditional healers. Quantitative data were analyzed descriptively, while qualitative data were interpreted thematically through the frameworks of structural vulnerability and embodiment. Findings suggest that younger age, limited education, marital and economic dependence, gendered control of household resources, subsistence livelihoods, and transport costs hinder timely care-seeking. Women's embodied experiences of malaria are shaped by poverty, seasonal food insecurity, and unequal household power relations, often leading to delayed treatment, reliance on prayer or home remedies, and irregular engagement with formal health services. Simultaneously, women demonstrate resilience through small-scale farming income, livestock ownership, social networks, and faith-based support. The study argues that malaria in pregnancy is a socially embedded condition influenced by inequality and recommends household-level support, transport or cash assistance, and collaboration with community and religious leaders to promote equitable access to care.